They say that by seeking and blundering – we learn. Psychiatric history has established profound evidence of seeking and blundering on the development of medicine, therapy, and healthcare practices. The evolution of psychiatric treatment is revealed in the book Mad in America by Robert Whitaker. We can all agree that mental illness, emotional disturbance, and abnormal behavior is a prominent matter in the neuroscience field of study. Schizophrenia was, and still is, a major mental disorder appraised globally in an attempt to find a cure. It entails a breakdown in the connection between thought, feeling, and conduct, expressing a distorted perception and improper behavior and feelings. Throughout the book, we witness patients being exposed to a series of treatments that affected them in several ways physically, emotionally, and physiologically. Success rates for some treatments were often low but several factors influenced the development and continuance of these treatments. While many view psychiatric history as an inhumane period, others consider this historical time imperative to the advancement of science, therapy, and medicine.
Three centuries ago, European and American societies proposed an idealistic concept about “lunatics” being less than perfect. In the early 1700’s, “lunatics” were incarcerated to keep them away from the rest of society. The living conditions were often rigid and cruel. In prison, the treatment for these individuals would involve the bleeding of patients, blistering them, putting them through starvation, placing them in tranquilizer chairs, spinning them, submerging their heads in water and holding them there until they lost consciousness. This methodology demonstrated maltreatment by the negative implications it brought. There were high death rates from starvation, hemorrhages, diseases, and often left them with no permanent improvements. How could such ‘Doctors’ interpret these results as a cure for mental disorders such as schizophrenia? Well, the basis of these treatments were due to propaganda from various authorities who advocate that these individuals were superhuman, wild beasts, and animal-like creatures that should be away from society for the safekeeping of civilization (Whitaker, 6). These first major types of treatments focused on physically weakening the “mad” because ‘doctors’ believed that inflicting serious pain, eliciting terror, and fatiguing these individuals could in fact reduce the strongest “madman” into a miserable and whimpering state of mind. This allegedly worked by shifting their raving thoughts toward their physical perceptions in hope that they would attain consciousness of who they truly are. Even when all the forms of treatments did not show to permanently cure, if any, mental disorders, the financial opportunity was the main driving factor that encouraged the development and usage of these therapies. The question of morality arises and perhaps argues that in a world full of greed, we must learn to put people before profits.
With the desire to treat the “mentally ill” more ethically, the first moral-treatment asylum in 1817 was opened by the Philadelphia Quakers. Pinel, a physician known as the father of moral treatment, developed his beliefs from the work of Jean Baptiste Pussin, that a nurturing environment would heal the patient through becoming self-aware along with therapy that was designed for the specific needs of the “mad” (Whitaker, 22). This was the next major treatment that was expressed in the book which portrayed the theme of kindness and empathy toward the “mentally ill” individuals. It was insisted that harsh remedies were no longer the key to restoring these patients back to “normal”. Here, patients would perform functional activities such as gardening, sewing, reading, writing, and even played board games. Doctors implied that this therapy worked because, in the beginning, this form of treatment was producing remarkable results after discharging them by being able to successfully integrate them as a functional member of society. They argued that overused nerves would transmit faulty impulses to the brain which triggered hallucinations and strange behavior characterized by the “mentally ill” (Whitaker, 30). Although this type of individual therapy was desired, they failed to prepare for the long-term implications of giving undivided attention to each and every one of these individuals. The more people found these facilities, the more patients that wanted to get moral treatment. With high numbers of patients compared to staff, it was only a matter of time before no one got any undivided attention and they would continue to suffer their symptoms at these asylums. Society began to wonder if their upkeep was even worth the effort and this outlook gave birth to the “Eugenic movement”.
Following the 20th centuries, attitudes of despair, led to a shift in paradigm. The Eugenist urged segregating and forcibly sterilizing these individuals to control the spread of these “inferior genes”. In 1929, doctors found sterilization to be therapeutic (Whitaker, 62). It was reported that men and women actually appreciated these operations in an effort to better themselves and society for quite a while. The stories, money, and propaganda convinced the public easily for support because society wanted to be happy and eugenics offered just that. Although this strategy proved no empirical results in making society happy or curing any psychotic disorder, it took roughly 13 years for the mentally ill to realize how they were affected. The patients became aware that they were just as capable of bearing a child like everybody else. Now, they consciously had to live with resentment of sterilization. All of these circumstances made it easier for other physicians or doctors to impose new treatments because society appeared to be receptive about the next “best” cure.
Physicians, scientists, and doctors quickly reacted to this situation in search for financial, recognition, or fame opportunity. The increase in demand for effective moral treatment and the inability to fulfill those demands lead to the transformation of asylums from a medical healthcare facility into a confinement place for the mentally ill. A multitude of therapies emerged into the market with promises to cure the “mad” once again. The next major theme of treatment turned back to physical remedies in an attempt to cure psychotic disorders. The list was comprised of hydrotherapy, insulin coma, Metrazol convulsive therapy, prefrontal lobotomy, and electroshock.
In hydrotherapy, patients were strapped onto a hammock and submerged in a bathtub for a period of time until the disruptive patient would quiet. Patients would experience a terrible feeling of burning up and suffocation. Doctors proceeded this treatment because they claimed to have gathered statistical evidence, that proved effectiveness, as part of their results. The idea was that lengthy baths would alter body temperature, respiration, and red-blood-cell counts. As we now know, this indeed does not cure any mental disorder and a decrease of red blood cells is actually detrimental to one’s health. In addition, psychiatrist Sakel proposed that insulin coma therapy would alter the mind, personality, and ego of the psychotic after they awaken. Despite the number of negative implications such as brain damage, destruction of the cerebral cortex, and the risk of death from hypoglycemia, Sakel could not neurologically explain how this helped the psychotic. Yet he reasoned that it would selectively destroy or quiet down the affected brain cells that were beyond the point of repair (Whitaker, 86). Furthermore, schizophrenics were even put through cold blankets cooled by refrigerants that diminished the body’s temperatures of the patient by 10 to 20 degrees Fahrenheit below the norm. This would kill or knock these individuals out. Sakel explained that those individuals that returned to consciousness after being physically warmed up, would in turn restore the mind of the mad. Doctors even attempted to inject animal extracts from the animals ovaries, testicles, pituitaries, and thyroids. They also tried administering horse serum into the spinal fluid as a belief that it could cure schizophrenia. Truth be told, all this caused was physical discomfort, backaches, headaches, and vomiting (Whitaker, 80).
In contrast, following insulin coma therapy – metral convulsive therapy was introduced, which produced intentional epileptic seizures as a remedy for schizophrenics. This produced brain trauma for the patient. Many reasons the doctors stuck with this kind of treatment was because electricity was cheap, easy, reliable, and quick. The concept of this treatment implied that the "unwanted personality" would be eliminated after electrifying the temple (Whitaker, 98). This treatment was ineffective and often lead to the destruction of higher cognitive processes and emotions. The continuous usage and development of electroshock served the facilities with a new way to frighten, control, and punish the patients. Electroshock was described in the book to “replace the old whip for controlling the mentally ill” (Whitaker, 106).
Apart from the physical treatment, doctors developed a chemical form of therapy in the form of a pill. A fascinating type of treatment emerged in the 1960’s that disrupted the markets. This treatment was neuroleptics. Medical treatments turned to drugs that were marketed to be “safe and antischizophrenic” to the public. Generously speaking, the doctors honestly believed it was “safe” in the beginning with intentions of doing good for the most part. Thorazine and Clozapine were two of many infamous pharmaceuticals. With Thorazine, brain function was hindered, inhibited the central nervous system, gave a feeling of emptiness, and drowsiness were common side (or perhaps main) effects patients experienced. Some even lost body mobility (Whitaker, 144). Clozapine, similarly, affected motor control along with many other neurological receptors such as dopaminergic, serotonergic, adrenergic, and histaminergic. The disruption of these receptors led to many detrimental effects like – hypotension, blurred vision, fatigue, memory loss, and the list goes on (Whitaker, 279). You might notice the enormous amount of negative effects that neuroleptics created, but did doctors present any real evidence that neuroleptics helped cure mental disorders and schizophrenia or was there more than met the eye?
Medical facilities and hospital administrations were battling to budget with overcrowded facilities. This in part, was a reason why they would welcome dependable drugs that would tranquilize rowdy patients. Researchers argued that neuroleptics adjusted the behavior of the patients just enough to make them civilized and accepted in society. In other words, neuroleptics were classified to suppress the symptoms, rather than to cure the disease” (Whitaker, 145). In concurrence with sales, millions of dollars were being generated by pharmaceutical companies regardless of the multiple harmful effects. Even with “atypical” drugs, which was another major treatment for schizophrenics, they were no better than the last. But “atypical” drugs had their run because of financial greed from the pharmaceutical companies. So who was out to stop them? The World Health Organization conducted an empirical study in 1970’s and 80’s and evidently found that poor countries that had no access to neuroleptics or treatments, had a better quality of life dealing with their mental disorders and granted them more life longevity (Whitaker, 284). But with American society having nothing else to fall back on, the pharmaceutical companies and society kept ignoring the WHO studies and proceeded driving sales. At the end of the day, was anybody listening to the patients? They wanted to be treated with “dignity and respect” and all they wanted was “love, food, and understanding” (Whitaker, 221). Instead, what they got were painful treatment and drugs.
Journalism implored the usage of new treatments because the next best therapy or drug was “supposedly” to be better than the last. Many of them had parallel effects from prior treatments while other drugs or therapies would bring a new effect. Treatments like frontal lobotomy, insulin coma, convulsive therapy, metrazol convulsive therapy, and electroshock were all brain damaging therapies that involved physical tormenting. Neuroleptic and “atypical” drugs also hindered vital brain function, rather, but in the form of a pill. It was more of a neurological and chemical interference that led to the disruption of the nervous system and its neurotransmitters. One very notable difference was the ideas of the “causes” of mental disorders. For instance, Benjamin Rush thought madness was caused by an excess flow of blood to the brain. Henry Cotton thought that bacteria caused mental disorders and any that was linked to them would be remove. For example.he removed teeth and other body parts in expectation to get rid of the madness. Manfred Sakel, miraculously believed the diseased brain cells were blameworthy for psychosis and insulin coma would terminate that. Moniz thought frontal lobotomy would eliminate nerves fibers that were kept in those areas (Whitaker, 96). Additionally, a distinguishable similarity between therapies, excluding moral treatment was that they all continued the usage and development of treatment for money, power, or control.
In my opinion, the best major groups of treatment were moral treatment and tranquilizers with some modifications. To elaborate on that, moral treatment would encourage the mentally ill to perform activities of daily living at the medical institutions that prepared them for the reintegration of society. Occupations like gardening, reading, writing, and other human interacting activities are essential to human development and seemed to work quite well for many years (Whitaker, 23). Likewise, neuroleptics possess the ability to suppress negative symptoms and even today, we still use more advanced narcotics to manipulate neurotransmitters and such, but with moderation. The appropriate doses are critical because like we saw in the book, “study after study showed that high doses caused harm” (Whitaker, 210). On the contrary, the worst group of treatments, in my opinion, was all of the traumatic physical remedies. None of them actually cured any mental disorder or schizophrenia and all they did was negatively alter the well being of these individuals. This was unethical and immoral treatment and why we now have rules and regulations about experiments.They grant you a proper consent form before undergoing any sort of human experiment (Whitaker, ).
The bond between psychiatry and professional researchers, were in conflict with each other to prevent or expose the truths about these treatments. Despite the conflict, curiosity and innovative thinking led to the evolution of ethical health care practices, therapy, and medicine. The exposure of this information in the book Mad in America By Robert Whitaker, made us aware of psychiatric history and how the treatments affected the patients physically, mentally, and physiologically. It made us conscious of neuroscience as a prominent field of study and development. This awareness contributes to the advancement of treatments for schizophrenia and other therapies for the mentally ill, emotionally disturbed, and individuals with abnormal behavior. We hope to have learned valuable lessons from psychiatric history so we can effectively build, create, and apply those lessons to future research for the betterment of society.